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The beauty of telehealth is that it connects patients and providers through technology that transcends boundaries. But when that connection crosses state lines, your healthcare organization could find itself responsible for complying with regulations from jurisdictions hundreds, maybe thousands, of miles away.
Or from states just down the road.
Many of those are stricter than the federal regulations, and many cover issues that the federal government doesn’t. Here are some of the key issues to look out for.
Differing reimbursement structures and rates
Reimbursement structure and rates vary by state and form of telehealth. For instance, all states pay Medicaid reimbursement for some form of live telehealth, but in different ways, and all states reimburse for interactive, real-time telehealth. However, only 14 reimburse for sessions where the patient records a call for later physician review (store-and-forward), and only 22 reimburse for remote patient monitoring of recently discharged hospital patients. There are eight states that reimburse for all three telehealth methods.
There are two opposite views about reimbursement rates. One view is that a service is a service, so being virtual or in person shouldn’t affect reimbursement.
The other penalizes telehealth for its efficiencies. In face-to-face visits, “there are built-in inefficiencies that isn’t time spending with the person,” says Dr. Katherine Dallow, vice president of Clinical Programs at Blue Shield Blue Cross of Massachusetts. “I probably spend somewhere between two to five minutes per patient moving from one room to another or pausing to document or checking something on their file or handing something off.” With less provider time and less pro rata overhead, some states reason, there should be less reimbursement.
Forty states have their own private payer telehealth reimbursement policies, and six have private payer parity laws requiring the same reimbursement for in-person and telehealth care.
Stricter privacy protections
The Health Insurance Portability and Accountability Act (HIPAA) is the federal umbrella protecting privacy and confidentiality of patient records, but states are allowed to go beyond it. Many do.
For example, if there’s a breach of privacy, HIPAA requires that the patient be notified within 60 days. Some states shorten that to 30 days, and California shortens it to ten. Some states also require hospitals to notify the state attorney general and the three major credit reporting companies: Equifax, Experian, and TransUnion. If there’s a breach of an out-of-state telehealth patient’s confidentiality, do you know what the originating state requires?
Multi-state provider licensure
Almost all states require physician licensure where the patient is (also known as the originating location). Same for nurses, nurse practitioners, physicians’ assistants, clinical psychologists, registered dieticians, and physical therapists. Different states have different licensing procedures, and there’s no federal umbrella. That’s something you’ll need to look out for, not only with faraway states, but also in New York, New York; Chicago/Hammond, Ind.; Texahoma, Texas/Okla.; or any of 84 other communities that straddle state lines.
(Speaking of licensure, is your hospital licensed to provide telehealth services? In how many states?)
Can doctors prescribe online?
State regulations for phone-in prescriptions from the late 1990s adapt pretty well to online prescriptions today. The problem is, they differ from one state to the next. Different states have different regulations on just what a valid prescription is. About whether the doctor can prescribe without seeing the patient first, and whether seeing a patient on a computer screen is really “seeing.” About whether there has to be a previous doctor/patient relationship, and whether that relationship can be remote or has to be face-to-face.
Related: Interstate regulations aren’t the only telehealth complexity. Check out this blog post for more: Telehealth compliance considerations: looking ahead.
Two ways to keep up; one is practical.
Complying with more than 50 sets of regulations takes a lot of attention to detail and a lot of reading. One way to keep up is with sheer effort: health organizations designate one or more people to read and track all the regulations that affect them.
A better, more practical way is to rely on expert compliance professionals and nationally respected law firms to keep you up to date on interstate issues in telehealth regulation. YouCompli users select the agencies that matter to their organizations and receive updates and resources to help them know about new regulations, decide their applicability, manage policy changes, and verify compliance.
Are you looking for ways to track telehealth regulations in all the states your patients receive treatment? Take a look at YouCompli, the only healthcare compliance software combining actionable, regulatory analysis with a simple SaaS workflow.
Jerry Shafran is the founder of YouCompli.